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o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD PAGE_ Lor_]
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2 OF LABS & RESEARCH —
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o SDG# LABORATORY WESTCHESTER COUNTY C
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NAME MUCDR ADDRESS
CONTACT
VALHALLA, 71^7 YORK
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00 SAMPLING ANALYSES —
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00 LABORATORY SAMPLE PESTI
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SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS, ETC) o
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I. SAMP D AND RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: J SIGN:/Y) SIGN: SIGN:
PRINT: MY ' ACoUB PRINT/c PRINT: PRINT:
FIRM: I
DATE:
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DEP TIME: jC:ZsA FIRML4 TIME: 02 . FIRM:
DATE: TIME:
FIRM:
DATE: TIME:
II. RELINQUISHED BY: 11. RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: SIGN: SIGN: SIGN:
PRINT: PRINT: PRINT: PRINT:
FIRM: FIRM: FIRM: FIRM:
DATE: TIME: DATE: TIME: DATE: TIME: DATE: TIME:
III. RELINQUISHED BY: III. RECEIVED BY: ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: SIGN: SIGN: SIGN:
PRINT: PRINT: PRINT: PRINT:
FIRM: FIRM: FIRM: FIRM:
DATE: TIME: DATE: TIME: DATE: TIME: DATE: TIME:
EVIDENCE SAMPLES TAMPERED WITH: NO YES N/A SAMPLES DISPOSED OF ON:
IF YES 5d ( Rrs BY:
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NYC-WTC_000027886Source: NYC Law Department, mirrored locally